Measuring Control: How can Response to Asthma Treatment be Measured?

Current monitoring of childhood asthma focuses on the level of asthma control and reduction of future risk to the patient. However, guidelines are not clear in their recommendations on the best strategy to monitor asthmatic children. As asthma is a heterogeneous disease with symptoms, airways obstruction, airways hyperresponsiveness and chronic inflammation as the principal components, no single outcome measure can be expected to adequately assess asthma control. To determine the level of control, standardized questionnaires like the asthma control test (ACT), asthma control questionnaire (ACQ) and asthma therapy assessment questionnaire (ATAQ) may be used. Whether the use of such questionnaires actually improves asthma control remains to be shown. Spirometry and measurement of reversibility are recommended at least once per year to assess control and future risk. There is no need for bronchoprovocation testing as a routine monitoring tool in childhood asthma, but airway hyperresponsiveness might be important in estimating future risk. The fraction of nitric oxide in exhaled air (FENO) reflects eosinophilic airway inflammation. Recent studies only showed modest effects on asthma outcomes as a result of FENO monitoring in children.